Cortés, M. E., & Alfaro, A. A. (2014). The effects of hormonal contraceptives on glycemic regulation. The Linacre quarterly, 81(3), 209-18. https://doi.org/10.1179/2050854914Y.0000000023
Cortés ME, Alfaro AA. The effects of hormonal contraceptives on glycemic regulation. The Linacre quarterly. 2014;81(3):209-18. doi:10.1179/2050854914Y.0000000023
Cortés, Manuel E., and Andrea A. Alfaro. "The effects of hormonal contraceptives on glycemic regulation." The Linacre quarterly, vol. 81, no. 3, 2014, pp. 209-18.
A 2014 narrative review concludes that hormonal contraceptives influence how the body handles blood sugar. The authors describe studies of different sizes on pills, an implant, a patch and a ring. Several found higher glucose or insulin responses in users. One large study found no change in glucose tolerance with pills made with a progesterone-derived progestin.
Study at a glance, narrative mini-review: Hormonal contraceptives influence how the body handles blood sugar. Source: Cortés ME et al., 2014, PMID 25249703.
Key Findings
Wynn and colleagues studied 2,205 women: 1,628 pill users, 577 non-users. Two progestin types went with altered glucose tolerance. A progesterone-derived progestin showed no change in glucose tolerance.
Godsland and colleagues compared 1,060 pill users with 418 controls. Combination pills went with higher glucose, insulin and C-peptide responses, by dose and progestin type. Progestin-only forms had minor effects.
A cross-sectional study of 1,290 healthy women (Simon and colleagues) found higher 2-h plasma glucose and higher fasting plasma insulin in pill users than in non-users.
In 42 women over 9 weeks (Piltonen), glucose area under the curve rose with oral, patch and ring use. Fasting glucose held steady; fasting insulin rose with oral and vaginal use.
Among Watanabe and colleagues' 186 women, low-dose pill users had lower insulin sensitivity than controls. High-dose users did not differ from controls.
Interpretation
This is a narrative mini-review. The authors searched seven databases in English and Spanish and reviewed 24 references. The authors summarize studies one by one and report no pooled estimate. Studies with a stated duration ran from 8 weeks to one year, and the authors call two small ones inconclusive. The mechanism section includes rat and mouse experiments. Findings differed by progestin type, dose and route, so no single result covers every product. The authors write that current information cannot rule out long-term effects, and they argue that health professionals have an ethical duty to inform users of risks.
RRM Context
Restorative reproductive medicine looks for root causes and works with the body's own function. The review adds glucose regulation to the effects it links to suppressive medications. The authors name fertility awareness-based natural family planning as an alternative free from side effects and report no data on it. They add that fertility awareness can help assess a woman's health.
Our editorial summary of this paper, not the article's abstract.
Abstract
A number of side effects have been linked to the use of hormonal contraceptives, among others, alterations in glucose levels. Hence, the objective of this mini-review is to show the main effects of hormonal contraceptive intake on glycemic regulation. First, the most relevant studies on this topic are described, then the mechanisms that might be accountable for this glycemic regulation impairment as exerted by hormonal contraceptives are discussed. Finally, we briefly discuss the ethical responsibility of health professionals to inform about the potential risks on glycemic homeostasis regarding hormonal contraceptive intake.
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